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Emergency Medical Minute


Mar 22, 2022

Contributor: Aaron Lessen, MD

Educational Pearls:

  • Tramadol is often thought of as a mild-opiate to use for analgesia, but it is a more complicated drug
  • Tramadol needs to be metabolized into an effective drug making it not pharmacologically reliable
    • 3-10% of people cannot metabolize tramadol and it does not work
    • Some others over-metabolize tramadol and it causes greater effect
  • Studies have shown it is not any better as a acetaminophen or ibuprofen for analgesia, it can lower a seizure threshold, and it acts to inhibit serotonin reuptake
  • Recent study evaluated all-cause mortality of tramadol compared to codeine and found tramadol had nearly double the all-cause mortality as those prescribed codeine
  • Overall tramadol has many risks and should be critically evaluated before prescribing


Dhesi M, Maldonado KA, Maani CV. Tramadol. [Updated 2021 May 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from:

Association of tramadol vs codeine prescription dispensation with mortality and other adverse clinical outcomes Xie J, Strauss VY, Martinez-Laguna D, et al. JAMA. 2021;326(15):1504-1515.

Summarized by John Spartz, MS4 | Edited by Erik Verzemnieks, MD


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